HomeMy WebLinkAbout3150 KILLYBROOKE LN - Building Permits CITY OF COSTA MESA
BUILDING DIVISION
). �. DEVELOPMENT SERVICES DEPARTMENT P RMIT NUMBER
PERMIT
03-00464
%Pomo se
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa. tLDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626
Job Address: 3150 KILLYBROOKE LN Status: ISSUED
Suite: Applied: 03/24/2003
Vicinity: SIDE YARD Issued: 03/24/2003
Parcel Number: 14102219 Zoning: R1 R1
ApplicantddressLEWIS, RODNEY A TR ISSUED BY:
Address: 2911 CLUBHOUSE RD
Phone: 714-549-8664
COSTA MESA,CA Zip: 92626
Owner: LEWIS, RODNEY A TR
Address 2911 CLUBHOUSE RD )
Phone: 714-549-8664
COSTA MESA,CA • Zip: 92626
Contractor:
Address:
Phone:
Zip: License:
Arch : Eng:
Address: Address:
. Phone: - Phone:
Zip: License: License:
SCOPE OF PERMIT
INSTALL 6 FT HIGH BLOCK WALL ALONG 60 FEET DEPTH ON RIGHT SIDE PROPERTY LINE AND 5 FT RIGHT SIDE YARD.
FEE SUMMARY
Plan Check: $31.14 Calc Valuation: $1,300.00
Permit: $47.90 Claim Valuation: $0.00
SMIP Res: $0.50
SMIP Corn: $0.00
Other: $0.00
Inspection: $0.00
Total: $79.54
PLANNING &ZONING
SETBACKS
MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0
ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0
PARKING Existing: 0 Required: 0 Proposed: 0
NOTES:
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations.(Ord. No.92-28,§ 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714)754-5626
2446-46(6/00)
DECLARATIONS (----) ,
WORKERS'COMPENSATION DECLARATION: .
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of th work for_ which this permit is issued.
My workers'compens ti Ins a e carrier and ' number are'. W OAA
/,`L_`�
Carrier: rs i Policy Number:
his section need not be completed if the permi is valued at one hundred dollars($100)or less.)
I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of California,and agree that If I should become subject to the workers'compensation provisions of Section 3700 of t/he Labor Code,I shall forthwith
comply atu these pro ' ion . 1/\
Applicant Signeturefi.r1 /�. i.��c� Date: 3 2
WARNING:FAILURE TO SECURE WORKE,$COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES A CML FINES UP TO ONE HUNDRED
THOUSAND DOL-ARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,end my license is in full
force and effect.Lic # Class#
Contractor's Signature: Date:
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
Lender's Name: Lender's Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,Improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit
to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars($500).):
❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec.
7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is
sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.).
I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions
Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
❑ I am exern under sec. Business end Professions Code for this reason: _�At�� a
Signatur • ar� .
Expires:
Verification of Ownership by(type of document,i.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,California Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes 0 No
(Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has al any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Yes 0 No
(Section 25533 of the Califomia Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑Yes ❑No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application aPermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? U Yes L I No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No
(If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
7 11 a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No
8 (If'yes",attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is
correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize repress tatives of the City of Costa Mesa to enter upon the
above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by his_permit ntil final i spection.
_ .1.—,_ . - r- 3 V.� 0Je
Signatu • :.al Owner(s) Date
And/Or Authorized Applicant Date
CODE t, MUM= PATE INTITIA16 CODED INSPECTION TYPE • RATE INTmALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof 210 Final Electrical
KD. �
201 Final Block/Retaining Wall
-7-07 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition - 250 Final Building/Occupancy
OP
•11T1S SKETCH IS FOR INFORMATIONAL PURPOSES •SOLID WALLS/FENCES BETWEEN 2'6'&6'IN HEIGHT SHALL
ONLY. APPLICANT IS RESPONSIBLE FOR PROVIDING BE SETBACK AT LEAST BY FROM FRONT PROPERTY LINE.
AN ACCURATE REPRESENTATION OF THEIR PROPERTY
IN CASE THE SHAPE AND SIZE DO NOT CORRESPOND •SOLID WADS/FENCES SHALL NOT EXCEED Y 6'IN HEIGHT
WITH THE INFORMATION PROVIDED ON THIS SHEET. WITHIN 10'OF THE FRONT PROPERTY LINE(NOT CURB LINE).
•VERIFY DISTANCE FROM CURB TO PROPERTY LINE
AND SHOW ON PLAN. VERIFICATION FROM THE CITY'S
PNCTNEERING DIVISION IS REQUIRED. CALL(714)754.5343
FOR INFORMATION.
APPROVED
CITY OF COSTA MESA
NILI PLANNING DIVISION
SUBJECT TO BLDG. DEPT. REG. ral
- - NOTE:ADDITION , DELETIONS,
'' OR CORRECTIO S SHALL BE
APPROVED BY TH PLANNIMG DIV.
, RESIDENCERCSOBICE '
BY: jAmS2O3
so3- DD6 y :fit
M (( (oF't-
wafagoacci O
O a
g 31 yo �9 g ff
• kiLL met g, a
i REDDEN¢ RESIDENCE
RE90EN¢ RE9DEN¢ I
v
- -3.- E
1 6' Md Elea NULL SET BACK
%�_-- - - I DIVI IONp '
T1'OFI DSAAF$TY
STtebuiper
�` DatefaCo M t°n as swrthoutawr enpe at ell t nes end'Is u�la Ito
Thhis plan end ron from dre Dhbs on:la 41%
BLOCK WALL LAYOUTIry
nfIi�� �nnRoLto6eanYwoe" IIrdina I�Ea q�tln onarb nceendo,Starekw.SO2 meMMaiKy u a)with d vcvd 4me bLil ��
J — ! r y,,,aum(ce.
PLANNING DIVISION ' l� _
J _fi 1
t
I 1
TYPICAL 611 CONCRETE BLOCK FENCE
Cement Coping Optional i GENERAL— NOTES
Channel Block With 1.3/80 Illi ■— _ii
Horizontal Top of all
Fences N '-= MI 1 . MORTAR: One Part Plastic Cement, and
Three Parts Sand
GROUT;
For Fences 5'or Less t0 s One Part Cement Three and
Ven. Bars 3/B"¢at 4' -0" O.C. Oil o wit- I One Half Ports Sand'9 a r COPING: One Part Cement, Three
For Fences Higher Than 5' !� " u 'llII Parts Sand
Ven. Ban 3/8"g5 at 32" O.C. > w - r= - CONCRETE: Well Mixed 1:2-1/2: 3-1/2
a --_-- -•-" Max of 7- 1/2 Gallons of
Fill Cells Solid With Gr`o'ut' 'I'� '----' > "
1.
Where Steel Occurs � y _ Water Per Sack of Cement
ReinfnMt a
rcing Steel Sha I !til y .7 m GROUT MAY BE INPOUREDCELLS FROM THE TOP
ConformOF THE to Sec.A.tsy39 IIIYYYY atl� �, O _- . - OCCURS.FE NCE CELLS WHERE STEEL
A.S.T.M. ' !'�� ^' 2 fr I '—• 1 �.J CELLS AND AREAS OF HORIZONTAL REIN
All Steel to be Lapped ` I ` C4 %° •
--- l FOR CEMENT SHALL BE CLEAR,CLEAN&
'.'of . II ty, v I
i� FREE OF ALL MORTAR DEBRIS,ETC.
24"or to Code tis y. ! -
,p
,- A I �r
• NATURAL GRLto ' ti 'Il �
• '. ;,f6! l v' .: . I • X11 I —e-
I o -- '
TWO 3/e"O BARS' .- . �
CONTINUOUS TOP. U "
&BOTTOM' KIOTH 10 16' 0 C MAX
t• I& -1 -SEE- CHART - s - - �'
HOR,AST EEL MUST BE TIED INS — L. 'BELOW - : 4
PLACE AT TIME OF TRENCH�1 y' ^ , OC Pill ;.F C ART MT LOTH .� �,
INSPECTION. 'tele s I '/. THE HEIGTH or FENCE S 5,
S I . BFLOW BOTTOM OF FOOTiNGt' e'.
l"� . _,._� �l11 r° �� z" —1 SCALE'-5_ = I'
FOOTING REQUIREMENTS CHART •— . - z v
I WALL HEIGHT 6 ' S 4' -3' I<''T `'
t.. ..;••
WIDTH • 14" 14 12". . 12" ''" n " _
THICKNESS 10" 10 B " 8 " i '�'
• .e—
DEPTH OF EARTHTOOTH 24" 20" 16" 12" - - .
SPACING OF EARTHTOOTH 12' 14' 16' 16' -
l .
1 - .
BUILDING DIVISION
hr'
ll
I'S \ '• J
• 'F CITY OF COSTA MESA
°w9 BUILDING DIVISION
Hran
41- .� DEVELOPMENT SERVICES DEPARTMENT P RMIT NUMBER
- $L+ PERMIT
B00-01414
*en
'q'oamrA/5"s
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.\�LDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626
Job Address: 3150 KILLYBROOKE LN Status: ISSUED
Suite: Applied: 09/11/2000
Vicinity: RESIDENCE&ATTACHED GARAGE Issued: 09/11/2000
Parcel Number: 14102219 Zoning: R1 R1
Applicant: FUNKES, KENNETH ISSUED BY: - A
Address: 18567 PLUMOSA ST.
Phone: (714)964-7171
FOUNTAIN VALLEY,CA Zip: 92708
Owner: LEWIS, RODNEY A TR
Address 2911 CLUBHOUSE RD
Phone:
COSTA MESA,CA Zip: 92626
Contractor: FUNKES ROOFING
Address: 18567 PLUMOSA ST.
Phone: (714)964-7171
FOUNTAIN VALLEY,CA
Zip: 92708 License: 348877
Arch : Eng:
Address: Address:
Phone: Phone:
Zip: License: License:
SCOPE OF PERMIT
REROOF:T/O, 1/2"CDX PLYWOOD, 1 LAYER 15#FELT,APPLY 40-YEAR COMP SHINGLES.
26 SQUARES
FEE SUMMARY
Plan Check: $0.00 Calc Valuation: $8,200.00
Permit: $167.25 Claim Valuation: $8,200.00
SMIP Res: $0.82
SMIP Com: $0.00
Other: $0.00
Inspection: $0.00
Total: $168.07 - •
PLANNING & ZONING
SETBACKS
MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0
ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0
PARKING Existing: 0 Required: 0 Proposed: 0
NOTES:
•
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28,§ 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714)754-5626
2446-46(6/00)
DECLARATIONS
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to sell-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued.
My workers'compensation Insurance carrier and policy number are:
Carrier: Policy Number:
(This section need not be completed if the permit is valued et one hundred dollars($100)or less.)
❑ I certify that in the performance of the work for which this permit is issued.I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of California,and agree t If I s ecorne subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with these p 'sions.
Applicant Signature: - 2-41X, Date: I —f-tC)CD
WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT MI EMPLOYER TO CRIMINAL PENALTIES AND CIVIL RNES UP TO ONE HUNDRED
THOUSAND DOLLARE(5100,0011).IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license Is In full
force and effect.LIC.# /L1 r!/ n Class if
Contractor's Signature: Date: Y— —2-0e7
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
Lender's Name: Lender's Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit
to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars($500).):
❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec.
7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is
sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.).
❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions
Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
❑ I am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by driver's license. 0 Yes 0 No Driver's License No. Expires:
Verification of Ownership by(type of document,i.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,California Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? ❑Yes ❑No
(Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No
(Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 Does or will the applicant or present ar future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑Yes ❑No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes ❑No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application apermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? ❑Yes LJ No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes ❑No
•
(If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). _ __
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application,have all of the disclosures prescribed by Califomia Health and Safety Code Section 42303 been made? 0 Yes 0 No
8 (If"yes",attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Data:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is
correct.I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
IaDate
- ,� - t
o
And/Or Authorized Applicant
Date
CODE# INSFECRON TYPE PATE IIam9LS CODE! INSPECTION TYPE DEE IdEMALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final l 208 Final Plumbing
,I1
200 Final Re-Roof -1-✓Q'aa (IC 210 Final Electrical
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition 250 Final Building/Occupancy
PROJECT ADDRESS: 3150 K" "L`JH90Y.'�?.'' UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: B 058095
OWNER'S NAME: LEWIS MARK E TR
,A t ADDRESS: 2911 CLUBHOUSE RD PERMIT NO: B 058095 PLAN CHECK NO: N GOVT: N SUPP: N
•" COSTA MESA,CA 92626
CONSTRUCTION TYPE: V—N PERMIT TYPE: STR PURPOSE: ALT
ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION : T/OFF RESHT REROOF W/TIMBERLINE SHAKES SQ FT: 4 ,000
ADDRESS: UNIT:
CLAIM VALUE: 4 , 000 . 00 CALL—VALUE; 4 ,000 .00 GROUP OCC: R-3 /
PERMITTEE: TOM BYER ROOFING ( 714 ) 894-9618
ADDRESS: 15641 PRODUCT Al2 COMMENTS: SMOKE DETECTOR REQUIRED IN THE HOME
HUNTINGTON BEACH CA 92647 sty(* ***+e4i(*?(yETE****HESE*>E***** ************************************* *******est****
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am Been ed under provisions of Chapter 9(commencing with Section Z ONING REQUIREMENTS
7IXp)of Division .1 the Business and Processions Code.and my lice ,•• Is In lull lone and tiled. SETBACKS
CITY L €0, STATE UC.:47406, LA'': C39
n ` Signature:_ A- MAINBUILDING ACCESSORY BUILDING
WORKERS' IMPEN•ATIDN DECLARATION: thereby affir that I have. ..nificate of consent o self-insure or a certificate of Workers' FRNT: FT IN REAR: FT IN FRNT: FT IN REAR; FT IN
Compensation Insurance.or a cendied copy thereof(Section 3800.Lab.C). LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
POLICv ND.: 1 13 7 4 2 4 EAP.DATE: 04/01 /93
COMPANY: STATE PARKING REQ: PROV: PARCEL; 14102219 ME: REF NO;
1,-Cenuied ..py is h,eby furnished. ® Cenilied co 6 'ed with the city Building Division. PLANNING NOTES?...
0>
Applicant: )(%.(****************************************************************************
EXEMPT10 ROM HIKERS'COMPENSATION DECLARATION: (Tris section need not be completed if the pernit is for one hundred(5100)or less). D E V E L O P M E N T SERVICES REQUIREMENTS
I certify t .tin the performance Of the work for which this permit is issued.I shall not employ any person in any manner so as to become
subject to the Workers'Compensation Laws of California. ZONING APPROVED BY
DATE:
Date: Signature:
NOTICE:II.after making this declaration.you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY ; ./ DATE:
Code.you must forthwith comply with such provisions or this permit shall be deemed revoked. ' /�
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED BY• %f/j/>I� DATE- //- 9�/aY
which this permit is issued(Section 3097.Civ.C). **********************• ' ****ne*****3(*a(.!p*£.ne*.*. *..K.
LENDER: ************************************* A****************************************
ADDRESS: LEGALIZATION;N F E E SUMMARY STRUCTURAL SEGMENT; Y
OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/,RES GRADING
(Section 7031.5 Business and Processional Code: Any city of county which requires a permit to construct.alter,improve.demolish,or PERMIT 63 , 00 S
repair any structure,prior to its issuance.also requires the applicant for such permit to fife a signed statement that he/she is licensed
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business SMI P/NON—RES
and Prolessions Code)or that he/she is exempt therefrom and the basis for the alleged exemption,My violation of Section 7031.5 by PLAN
any applicant for a permit subjects the applicant to a civl penalty of not more than five hundred dollars(SWOT ISSUE FEE
I. as owner DI the property or my employees with wages as their sole compensation. will do the vArk, and the BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK \ TOTAL PAID DUE
❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS————> 63. 50 0 . 00 0. 00 63. 50 63a•50 . 00
does not apply to an owner of a property who builds or improves thereon.and who does such work himself/herself or through
imprrovemeor her nt is n esold within one year of completiorovided that such n flamownerare
wn have intended
the burden offered
of proving he/she did not build orf r the a propREVENUE DIVISION TOTALS--> COLLECTED: 63 . 50 OVER/SHORT: 00
for the purpose of sale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 63 . 00 . 50
❑ and Professions Cede: The Contractors'State License Law does not apply to an owner of property who builds or Improves thereon
and who contracts for such projects with a contractor(s)license pursuant to the Contractors'State License Law).l am aware ****************************************************************j(-**************
that proal of thein Worker's Compensation insurance should be provided to me. INDIVIDUAL F E E BREAKDOWN
❑ I am exempt under Section: B.&P.C. .
fpr this reason: TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
Date: Ower SFR 4000 ALTER BY VALUE RESIDENTIAL NOZONE 1 . 00 4 , 000 . 00
Ida hereby certify that 1 am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and END OF FEES
25534 and that I or any future building occupant wilWnll not(circle one)need to comply with said state codes and the requirements for a
permit for construction or modification from the Air Duality Management District.Residential construction applications are exempt from i
these provisions.
Dale: Applicant: EXPIRED
I hereby certify that I have read this application and state that the a.. •informatio is correct.I agree to comply with all city and county Incon Iplete Inspections
ordinances and state la lating to building construction arid her by tadze repre'nlatives of this city to enter upon the above.menlioned
Date
property for ins c1i0 yrposes. ' - - _
9dICA, 7 7c/ Signature: ( • Sig - -h
(/ 1.n I _ . . ' _
Driver's Li ense r Social Security#:
'
1641.46 White—Building;Green—Cade Enforcement Canary—Applicant:Pink—Revenuo:Goldenrod—Assessor 1'
,I
Ci NSTRUCTION AND PLANNING POOL PA
AP&ROVALS Permit #
Date Inspector APPROVALS Permit # Date Inspector
1. Temporary Electrical Service-or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd.
•
8. Foundation 59. Gas Pipe, 0 Undrgrnd., Test •
9. Water Pipe-Undrgrnd. • 60. Backwash Lines, P-Trap, 0 Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap 63. Heater &Vent-Final
13. Roof Drains 64. Plumbing System • Final
14. Rough Plumbing 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit#
21. Ducts,in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil
25. Roof Sheathing 7-(f1?y tOw� 74. Overhead Hydro
26. T•Bar Ceiling (Structural) & Monocoat C 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation : 78. FIRE PREV. FINAL
30. Drywall Nailing t HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final I 80. FOOD CERTIFICATE ISSUED
•
33. Final Electric • Notes:
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test
36. Hood Or Canopy
37. Final Factory Fireplace
38. Final Plumbing
39. Water Service-Final '
40. Gas Service-Final
41. Solar Domestic-Final
42. Backflow Preventer 11
43. Backflow Irrigation
44. Landscape Irrigation System EXP 1 R'E-0
9-1t15(�CtIOOf�'-
45. Sound Attenuation
46. Handicap Regulations tate ( tttpls ?' 5't
47. FINAL STRUCTURE & BUILDING ,
48. FINAL PLANNING i P
49. Electric Release to Edison '
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
OWNER HARBOR HALL OF FAME HOMES, INC. DATE DEC 1 1 1962
JOB ADDRESS 3150 Killybrooke Lane BUILDING PERMIT NO. J1
GENERAL CONTRACTOR Lifetime Res.Bldg. Corp. VALUE $19,_C55.00 f�!�:�41
AP No. LOT32 TRACT 4.355 FIRE ZONE DESCRIPTION OF WORK Res.w/att.Gar
INSPECTIONS Signature DATE GROUP I & J TYPE V ZONE RI
Soil ,CGt/ .tier
u/ . 7PERMITS ISSUED
Gas
/ / I SUBCONTRACTOR DATE 1. NUMBER
Water LG✓ 1.19-6'3
Rough Corn. Refrig. 0 Air Cond. 0
Rough Heating al II, y �!_."a dL-leg��..� _
Rough Plumbing i _2 of .f. 0 _ /2_2g- ,27387 k
Miscellaneous _—jJ d
Prop.Swr.Line 0 House Con. St.Swr. ❑ v.-Jo .� c� • �-,,7L G..9 `35.2Gf(\
Sprinkling System
Construction Pole bl I(,'1i
Underground 0 Power ❑ _/��
Rough Wiring /�//.S �'•��{3 �!� ftW2Gj.YLP� �2iB1I r� 1.S-1 __i_7-47-5---
- b..--
Trenches l— Forms pi' Steel Remf. 0 n'/g,�yc' I_2. t,3
Floor System ��� I-f7 63
Bond Beam 0 Steel Reinforce 0
Sheathing •h`
Frame and Flashing /� 3-R7- 3
Lathing — In 0 Out 0 dj' Siete c/-r'43
Plaster, brown coat /f'ifrft F`.ef'(j
Ref rig. 0 Air Cond. 0 Final
Heating, Final / 1 4'3
Plumbing Fixtures, Final �'—/—v3
rn,..,i nnc moor i or--.4 s -i -r ,
•
i sa i a . FEE RECEIVED
COSTA MESA BUILDING-SAFETY DEPARTMENT Lot 32, Tract l-§ t C ;lI
P. O. BOX 317 COSTA MESA. CALIFORNIA �J�RAAA,�`III��VVVI��000;
CITY OF COSTA M S
For Applicant to Fill In Completely , APPLICATION FOR PERMIT
TYPE OR PRINT �; i�
BUILDING
ADDRESS 3/50 /CI
jy 61-OPr G L/L(..
COSTA MESA. CALIFORNIA For Office Use Only
OWNER Harbor Hall of Fame Homes, Inc. I RECEIPT NO. B_C7T'.9 1 A
MAIL RECEIVED BY DATE RECEI D DATE ISSUED`�
ADDRESSP.O. BOX 2066 - LL,,,,�� iy:,Lyo I vcA/t/4-7il- DEC 1 I 196?
cm Santa Ana AK1 9-2204 ADDRESS
ARCHITCT
OR ENGINEER Jamison TNEO544-00110 COSTA MESA. CALIFORNIA
I�1y�p�
ADDRESS 225 "D" St. , Tustin FIRE
ZONE TYPE 1 GROUP v S7
CONTRACTOR Lifetime Residential Bldg Coo PROVED DATE
ADDRESS 2131 So. Artesia ZONING
_ - ZONE NO.OF USE OP NEW S.. %44,f'.,
CITY SantaAna
Q—/ I PLANS a I BUILDING w/ayf-ye-. .
LIC Tro. 208676- TEL. KI 9-2204 LEGAL DESCRIPTION L01- 3a 7/tr 3 sl'
SIZE 0001 Ho. oP BLDG°.
OF LOT 6000 . Now ON LOT 0 •.---_—____P.NO. —�-
USE OFYARDS EVES
EXISTING BLDG. None APPROVED ALLOWED
SETBACK LINE PROM C 361 .611 (CENTER LINE ST.1
CENTER OP STREET 5OI REAR YARD FRONT ./C
FT. IN,
SIDE YARD I LEFT 51 I RIGHT 51 R.SIDE -S FT. - IN,
DESCRIPTION OF WORK L.SIDE .S \FT. IN.
NEW k II ALTERATION/ I II ADDITION I REAR 3 C FT. G \I IN.
BUILDING I%MOVING
OFI I DEMOLISH I APPROVED G /,6/RP r DATE l%'/� L
SIZE ... ' 7 JIROOMS 10 STORIES 1EXTERIOR
CJS
ROOF
COVERING WALLPlastezlCOVERING Shake
USE OF BUILDING AND WORK TO BE PERFORMED
Si .le famil i-siden• = T
►'
f -/ / — pi
I HEREBY ACKNOWLEDGE • AT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABTHE AMOUNT SHOWN UNDER VALUATION IS FOR THE
• E IS CORRECT AND AGREE TO COM• PURPOSE OP ESTABLISHING A PERMIT FEE ONLY.
PLY WITH ALL CITY NCES AND ATE LAWS REGULATING
BUILDING CON®TRU . VALUATIONS ��� (=p
E ' II PERM( FEE $
SIGNATURPERMITTEE 0`tb./, JO.lOC1,,- 9 �j S O ^� ``,G
$�/J " - - PLAN CHECK $ ✓/J G'
AUTHORIZED AGENT /...5---/S S , YO 7 6-Co Q i—" el
TOTAL FEE $